Extrapleural Pneumonectomy

Extrapleural pneumonectomy (EPP) is one of two surgical procedures used to treat pleural mesothelioma. The other surgical procedure is called the pleurectomy with decortication (P/D). With EPP, the diseased lung is removed. However, P/D saves the lung. While P/D is a lung-saving procedure, many surgeons feel that EPP is more effective at removing as much of the mesothelioma as possible. Removing a greater amount of mesothelioma cells leads to longer survival times.

Extrapleural Pneumonectomy (EPP) for Mesothelioma

Some studies have shown that patients with mesothelioma who undergo EPP have a median survival time of up to 27 months. This is about three times the average life expectancy of most patients. Many patients who have undergone EPP have survived much longer. Some have even achieved survival times of over 10 years.

EPP is an important surgical procedure that has improved mesothelioma patient survival rates and increased individual life expectancies. It has also helped patients improve their quality of life by slowing disease progression and reducing painful symptoms.

What is Extrapleural Pneumonectomy?

Extrapleural pneumonectomy is an extensive surgical procedure used as a potentially curative surgery for pleural mesothelioma patients. It is a complex, extensive operation only performed by thoracic surgeons at large medical centers who are experienced in mesothelioma treatment.

EPP was the first pleural mesothelioma surgical procedure to significantly improve survival times. New medical technologies, such as robotics, are helping improve the EPP procedure to increase surgical success rates.

During the procedure, the surgeon removes the diseased lung, the parietal pleura lining of the chest wall, the pericardium (lining of the heart), a portion of the diaphragm (the muscle between the lungs and abdomen) and the nearby lymph nodes. During the procedure, the surgeon also removes all visible signs of tumors.

Goals of Extrapleural Pneumonectomy

Many doctors perform EPP as a curative surgery when they feel the patient has a good chance of achieving remission. This greatly depends on the individual case and is not always possible.

In some cases, EPP is performed because doctors feel it will increase a patient’s life expectancy and give them a greater chance of survival versus if they did not receive the surgery.

EPP also helps doctors gain control over the disease by removing tumors and slowing down the mesothelioma progression. It does this by preventing mesothelioma from spreading into the lymph nodes and other surrounding organs.

EPP is often performed in conjunction with chemotherapy and radiation therapy. When conducted before surgery (neoadjuvant), the goal of chemotherapy and radiation therapy is to shrink tumors. When conducted after surgery (adjuvant), their goal is to kill the remaining cancer cells. This multimodal treatment approach can further improve survival rates.

Extrapleural Pneumonectomy Surgery Candidates

The extrapleural pneumonectomy is designed to treat patients with stages 1 and 2 of pleural mesothelioma. It is most often performed as a curative surgery when doctors feel they have a good chance of removing all visible signs of mesothelioma.

In the later stages of mesothelioma, the disease has spread into surrounding tissues and organs, and the tumors cannot be fully removed. The operation is very extensive, so it does not benefit late-stage pleural mesothelioma patients. In fact, it presents a greater risk than benefit to them.

EPP has been conducted on stage 3 and 4 patients in a few cases. These are exceptions, however. Individual factors play a major role in determining someone’s eligibility for EPP.

Extrapleural pneumonectomy, like all surgeries, presents a risk to the patient. This is why doctors make sure that patients are physically fit enough to endure and recover from surgery.

Extrapleural Pneumonectomy Recovery

The EPP procedure is constantly improving so doctors can increase survival rates and lower the risk of operative mortality. These improvements have also made recovery a lot easier on patients.

Most patients remain in the hospital for two weeks following their surgery with another six weeks of recovery at home. Breathing with only one lung can be physically and emotionally exhausting. Therefore, patients work with a physiotherapist to help learn breathing and mobility exercises.

There are many success stories of EPP patients going on to life healthy, active lifestyles despite only having one lung. As the EPP procedure continues to improve, more pleural mesothelioma patients will have greater chances of survival.

Talk to your health care team about your eligibility for extrapleural pneumonectomy surgery for pleural mesothelioma.

Mesothelioma Support Team

Mesothelioma Hope was founded by a team of advocates to educate people about this aggressive form of cancer. Mesothelioma affects thousands of people each year. We help give hope to those impacted by mesothelioma.

View 5 References
  1. https://www.cancer.org/cancer/malignant-mesothelioma/treating/surgery.html
  2. http://thoracic.surgery.ucsf.edu/conditions--procedures/extrapleural-pneumonectomy.aspx
  3. https://www.ncbi.nlm.nih.gov/pubmed/25203873
  4. http://www.jto.org/article/S1556-0864(15)31820-7/abstract
  5. http://www.annalscts.com/article/view/1055/1584

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